妊娠期股骨头骨髓水肿综合征的临床分析

Clinical analysis femoral head bone marrow edema syndrome during pregnancy

目的探讨妊娠期股骨头骨髓水肿综合征的病因、临床表现、影像学特点及其与妊娠期股骨头缺血性坏死的关系和区别。方法收集2008-05至2014-11在北京航天总医院产科门诊以妊娠期股骨头缺血性坏死首诊,后确诊为妊娠期股骨头骨髓水肿综合征患者,共6例7髋,全部采用门诊治疗,急性期限制患肢活动,减少患肢负荷过重,按哺乳期要求补充钙剂等对症支持治疗,继续治疗原有基础性疾病,门诊定期随访,行影像学检查。结果全部病例经治疗后临床症状明显改善,未发现不良后遗症。X线平片示股骨头形状完整,关节面无塌陷,治疗前MRI图像显示T1加权像低信号,T2加权像或STIR成像高信号的现象,经治疗后完全消退,故预后与股骨头缺血性坏死区别明显。结论妊娠期股骨头骨髓水肿综合征是一种致病原因复杂的自限性疾病,应了解其临床特征,明确诊断,避免误诊及选择不正确的治疗方案。

Objective Analysis of the causes of femoral head bone marrow edema syndrome during pregnancy,clinical manifestations,imaging characteristics and its relationship with pregnancy options were ischemic necrosis of bone and distinction.Methods Collected from May 2008 to November 2014 in Beijing Aerospace General Hospital maternity clinic in pregnancy options were avascular necrosis bone first option,after the diagnosis of patients with femoral head bone marrow edema syndrome during pregnancy,a total of 6cases（7hips）as the research object,all of the outpatient treatment,the acute phase limit of limb activity,reduce limb overload,according to the requirements of calcium supplementation during lactation and other symptomatic treatment,continue to treat primary diseases,outpatient follow-up and imaging.Results All the patients after treatment significantly improved clinical symptoms,no adverse sequelae.Xray showed femoral head shape,articular surface collapse,before treatment MRI images showed low signal on T1 weighted images,T2 weighted imaging or STIR high signal phenomenon,after the treatment completely subsided,the prognosis of patients with ischemic necrosis of femoral head the difference is obvious.Conclusion Femoral bone marrow edema of pregnancy syndrome is a self limiting disease causes complex,be aware of the clinical characteristics,diagnosis,misdiagnosis and treatment to avoid incorrect selection.